Provider Demographics
NPI:1376672691
Name:GANLEY, ROSEANNE REEDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEANNE
Middle Name:REEDY
Last Name:GANLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3607
Mailing Address - Country:US
Mailing Address - Phone:281-296-2010
Mailing Address - Fax:281-292-0565
Practice Address - Street 1:4850 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3607
Practice Address - Country:US
Practice Address - Phone:281-296-2010
Practice Address - Fax:281-292-0565
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice